NON-PAYMENT OF ACCOUNTS AND REIMBUR*****TS TO MYSELF

Item: Sizwe Hosmed Medical Scheme
Rating: 1
Author: ELIZABETH P

I am posting this review in the hope of getting a response from Sizwe-Hosmed Medical Fund regarding ongoing non-payment issues.

Automated responses stating that a more substantive response to my problem and a suitable solution will be provided to me within 3-5 business days is a blatant lie. I have not received an email or a telephone call withing 3-5 business day from any of the Department I have emailed since November 2025.

I have phoned the Customer Services on 3 March 2026 and was assisted by Khethu. Aparantly there were no authorisation for the CT Planning Scan and the Radiation Treatment. After further investigation, it was discovered that there were in fact authorisation for both the CT Scan and Radiation Treatment. Khethu send the accounts back to the Claims Department to be processed and paid. The claims would have been processed and paid within 5-10 days. This has not happened.

The account for the planning CT scan for radiation done in January 2026 remains unpaid, as well as the account for the radiation treatment, which has been outstanding since February 2026. Despite multiple follow-ups, I have not received any feedback or resolution.

In addition, I am still awaiting reimbur*****t of R4,000.00 for payments I personally made for my first consultations with the Oncologist and Radiation Oncologist in November 2025.

I was diagnosed with Breast Cancer in October 2025 and was registered on the Oncology Program of Sizwe-Hosmed Medical Fund. Shouldn't these accounts and any further claims be paid directly for the Oncology Program? The Oncology Department was copied in emails sent on 18 March 2026 regarding the unpaid accounts. Only automative responses, as usual, was received.

This lack of communication and delay in payments is extremely frustrating.

If I do not receive a response by close of business today, I will escalate this matter further by lodging a formal complaint at the Council of Medical Schemes on Monday 23 March 2026.

I request urgent attention and clear feedback on when these outstanding amounts will be settled.

EAM Potgieter Member Number: ***

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Replies (2)

Sizwe Hosmed Medical Scheme's replyOfficial

20 Mar 2026, 10:17

Dear Elizabeth,

Thank you for submitting your query, and apologies for the inconvenience caused.
Thank you for the provided query reference numbers. We will investigate this matter and escalate the query for urgent attention.

We appreciate your patience.

Your Choice for Quality Care
Sizwe Hosmed team

Sizwe Hosmed Medical Scheme's reply20 Mar 2026, 10:17

Official

ELIZABETH P's updateReviewer Update

23 Mar 2026, 09:35

I have posted a review on 20 March regarding the non-payment of accounts as well as the R4,000.00 reimbur*****ts due to me. I have sent emails to the Oncology Department, Claims Department, Queries Department and Complaints Department also on 20 March receiving the same Auto-resposes and no replies to my emails within 3 - 5 days. This has been going on for months. As mentined in my previous review I have phoned your Customer Services on 3 March, spoken to Khethu and it was establish that there was in fact authorisation for the CT Plannning Scan and for my Radiation Treatment. These accounts was sent to your Claims Department to pay, aparantly withing 5 - 10 days which dis not happen. I was also not reimbursed for the R4,000.00 in total I had to pay for Dr. Naicker, Oncologist and Dr. Singh, Radiation Oncologist for my first consultations in November 2025 with them which was payable in cash. The last Claims Statements I have received was in December 2025, and the last Contribution Statement was received on 18 October 2025. This is not acceptable and what is more unacceptable is the fact that my claims are not being paid and that I am not reimbursed which is money I desperately need. Your reply to my review means nothing because you had not bothered in contacting me to resolve these issues. I want you to phone me as well as send me a formal email stating that these accounts will be paid. I have notified all the Departments mentoined above that a formal complaint will be lodged at The Council for Medical Schemes today:

As a member affected by non-payment, I am entitled to lodge a complaint with the Council for Medical Schemes (CMS) in terms of Section 47 of the Medical Schemes Act 131 of 1998.

Furthermore, the Curator is in breach of their legal duties, as they are mandated to ensure that the Scheme continues to operate in the ordinary course of business and remains compliant with all applicable regulations. The continued non-payment of claims directly contradicts the assurance that “all business operations, including authorisations, claims processing, and member services, are continuing as normal.”

Sizwe-Hosmed, currently under provisional curatorship, appears to be in contravention of the Medical Schemes Act 131 of 1998, particularly in respect of the timely payment of claims and the fiduciary obligations of the Curator to act in the best interests of members. While it is acknowledged that the Curator’s role includes stabilising the Scheme, any failure to process and settle valid claims timeously, including during system transitions, may constitute a breach of statutory and regulatory requirements as prescribed by the Council for Medical Schemes (CMS).

I hereby request urgent written confirmation of the status of the outstanding claims and a definitive timeline for payment.

ELIZABETH P's update23 Mar 2026, 09:35

Reviewer Update

I hereby request urgent written confirmation of the status of the outstanding claims and a definitive timeline for payment.